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Scott-Emuakpor R, Reza-Soltani S, Altaf S, Nr K, Kołodziej F, Sil-Zavaleta S, Nalla M, Ullah MN, Qureshi MR, Ahmadi Y, Rezvani A, Siddiqui HF. Mammary Paget's Disease Mimicking Benign and Malignant Dermatological Conditions: Clinical Challenges and Diagnostic Considerations. Cureus 2024; 16:e65378. [PMID: 39188449 PMCID: PMC11346752 DOI: 10.7759/cureus.65378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 08/28/2024] Open
Abstract
Mammary Paget's disease (MPD) or Paget's disease of the breast is a rare dermatological malignancy of the nipple-areolar complex that manifests with a spectrum of symptoms spanning from itching and redness to more severe indications such as breast lump, nipple-areolar complex destruction, or nipple discharge. It is predominantly associated with an underlying ductal carcinoma in situ or invasive ductal carcinoma. MPD often masquerades as other benign and malignant dermatological conditions, including eczema, atopic dermatitis, psoriasis, and squamous and basal cell carcinomas, leading to delayed diagnosis and inappropriate treatment. Only one-third of the patients present with a palpable lump; therefore, advanced age with chronic and unilateral lesions should raise concern for MPD. Our review article presents case reports of MPD imitating other skin conditions and underscores the key findings of clinical features and diagnostic workup to help differentiate the condition. A literature review revealed that studies emphasize caution regarding the sole use of mammography and ultrasound in diagnosing MPD, particularly in cases lacking a palpable lump. This highlights the MRI as a superior and more accurate imaging tool. However, any suspicious lesion must be biopsied to allow histopathological and immunohistochemical examination, since there are some cases where MRI findings were negative in the presence of a biopsy-proven MPD. This highlights the need for clinicians to investigate any suspicious lesion of the nipple or breast using the complete triple assessment approach to exclude an underlying malignancy. It is imperative to establish therapeutic guidelines to approach any nipple lesion to minimize the risk of misdiagnosing any underlying cancer, which can be potentially fatal if left alone.
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Affiliation(s)
| | - Setareh Reza-Soltani
- Advanced Diagnostic and Interventional Radiology Center (ADIR), Tehran University of Medical Sciences, Tehran, IRN
| | - Sana Altaf
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Kaushik Nr
- General Medicine, Rajiv Gandhi Government General Hospital, Chennai, IND
| | | | - Susana Sil-Zavaleta
- Dermatology, Universidad Anahuac, México City, MEX
- Dermatology, Hospital Ángeles del Pedregal, México City, MEX
| | - Monica Nalla
- Surgery, Rajiv Gandhi University of Health Sciences, Bengaluru, IND
| | | | | | - Yasmin Ahmadi
- Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, Muharraq, BHR
| | - Ali Rezvani
- Anesthesiology, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Humza F Siddiqui
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Dalton JC, Plichta JK. Paget's disease of the breast: Insights from imaging to guide surgical management. Am J Surg 2024; 231:16-17. [PMID: 38521673 DOI: 10.1016/j.amjsurg.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Juliet C Dalton
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27707, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27707, USA; Duke Cancer Institute, Duke University, 10 Bryan Searle Drive, Durham, NC, 27710, USA; Department of Population Health Sciences, Duke University Medical Center, 215 Morris St, Durham, NC, 27701, USA.
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Mariano L, Nicosia L, Pupo D, Olivieri AM, Scolari S, Pesapane F, Latronico A, Bozzini AC, Fusco N, Blanco MC, Mazzarol G, Corso G, Galimberti VE, Venturini M, Pizzamiglio M, Cassano E. A Pictorial Exploration of Mammary Paget Disease: Insights and Perspectives. Cancers (Basel) 2023; 15:5276. [PMID: 37958452 PMCID: PMC10650713 DOI: 10.3390/cancers15215276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Mammary Paget disease (MPD) is a rare condition primarily affecting adult women, characterized by unilateral skin changes in the nipple-areolar complex (NAC) and frequently associated with underlying breast carcinoma. Histologically, MPD is identified by large intraepidermal epithelial cells (Paget cells) with distinct characteristics. Immunohistochemical profiles aid in distinguishing MPD from other skin conditions. Clinical evaluation and imaging techniques, including magnetic resonance imaging (MRI), are recommended if MPD is suspected, although definitive diagnosis always requires histological examination. This review delves into the historical context, epidemiology, pathogenesis, clinical manifestations, and diagnosis of MPD, emphasizing the need for early detection. The classification of MPD based on pathogenesis is explored, shedding light on its varied presentations. Treatment options, including mastectomy and breast-conserving surgery, are discussed with clear guidelines for different scenarios. Adjuvant therapies are considered, particularly in cases with underlying breast cancer. Prognostic factors are outlined, underlining the importance of early intervention. Looking to the future, emerging techniques, like liquid biopsy, new immunohistochemical and molecular markers, and artificial intelligence-based image analysis, hold the potential to transform MPD diagnosis and treatment. These innovations offer hope for early detection and improved patient care, though validation through large-scale clinical trials is needed.
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Affiliation(s)
- Luciano Mariano
- Breast Imaging Division, AOU Città della Scienza e della Salute di Torino, 10126 Turin, Italy;
| | - Luca Nicosia
- Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Davide Pupo
- Radiology Division, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Antonia Maria Olivieri
- Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy;
| | - Sofia Scolari
- Postgraduation School in Radiodiagnostics, Faculty of Medicine and Surgery, University of Milan, 20122 Milan, Italy;
| | - Filippo Pesapane
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Antuono Latronico
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Anna Carla Bozzini
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Marta Cruz Blanco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
| | - Giovanni Mazzarol
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (N.F.); (M.C.B.); (G.M.)
| | - Giovanni Corso
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
- European Cancer Prevention Organization (ECP), 20122 Milan, Italy
| | - Viviana Enrica Galimberti
- Division of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141 Milan, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy;
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
| | - Enrico Cassano
- Breast Imaging Division, IEO—European Institute of Oncology IRCCS, Via Ripamonti, 435, 20141 Milan, Italy; (F.P.); (A.L.); (A.C.B.); (M.P.); (E.C.)
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Hudson-Phillips S, Cox K, Patel P, Al Sarakbi W. Paget's disease of the breast: diagnosis and management. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 36708338 DOI: 10.12968/hmed.2022.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Paget's disease of the breast typically affects postmenopausal women and is associated with an underlying malignancy. Skin changes are a common presenting symptom, as well as a lump, nipple discharge, pain and changes to the nipple shape. Imaging options include ultrasound for women under the age of 35 years or mammogram and ultrasound for women over the age of 40 years. The definitive diagnostic investigation is a tissue core biopsy. Cases are discussed by a multidisciplinary team to decide on the optimal management strategy. Management options are typically surgical and include breast-conserving surgery or mastectomy in addition to oncoplastic techniques. Sentinel lymph node biopsy is performed in all patients undergoing surgery. Adjuvant chemotherapy, radiotherapy or endocrine therapy can be used to treat concomitant invasive disease or ductal carcinoma in situ.
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Affiliation(s)
- Sarah Hudson-Phillips
- Department of Breast and Oncoplastic Surgery, Croydon University Hospital, London, UK
| | - Kofi Cox
- Department of Medicine, St. George's University of London, London, UK
| | - Puja Patel
- Department of General Surgery, East Surrey Hospital, Redhill, UK
| | - Wail Al Sarakbi
- Department of Breast and Oncoplastic Surgery, Croydon University Hospital, London, UK
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Lin CW, Chiang MH, Tam KW. Treatment of Mammary Paget Disease: A systematic review and meta-analysis of real-world data. Int J Surg 2022; 107:106964. [PMID: 36309195 DOI: 10.1016/j.ijsu.2022.106964] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because the lesions of mammary Paget disease (MPD) are often limited to the nipple-areolar complex, the extension of optimal tumor excision is inconclusive. Moreover, the risk of potential tumor upstaging is unknown; therefore, the application of sentinel lymph node biopsy (SLNB) is required for analysis. We systematically reviewed the real-world data to evaluate the optimal treatment and potential predictors of poorer prognosis for MPD. METHODS The PubMed, Embase, and Cochrane Library databases were searched for relevant studies. Clinical studies were included if they evaluated the outcome of positive rates of SLNB, prognostic risk factors of MPD, and survival outcomes of treatments of interest for MPD, including mastectomy, breast-conserving surgery (BCS) with radiotherapy, and BCS alone. RESULTS A total of 38 studies with 24,062 patients were retrieved. Compared with BCS alone (21.2%), mastectomy (5.9%; P < 0.001) and BCS with radiotherapy (8; P = 0.001) had significantly lower local recurrence rates. Patients with palpable tumors (30.2%) had significantly worse prognoses than those with impalpable (3.4%) tumors in metastasis (P < 0.001), and significantly higher local recurrence rates were observed in patients with underlying invasive carcinoma (6.7%) than those with noninvasive carcinoma (4.5%; P = 0.032). The positive rate of SLNB was 17% (95% CI: 0.115-0.226). CONCLUSION Except for MPD alone, BCS alone is not recommended for treating MPD with invasive ductal carcinoma and MPD with ductal carcinoma in situ. Moreover, a palpable mass, underlying invasive carcinoma, and positive lymph node status may lead to a poorer prognosis, which may be taken into consideration for the application of SLNB.
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Affiliation(s)
- Cheng-Wei Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Mazumdar A, Jain S, Jain S, Bose SM. Management of Early Breast Cancer – Surgical Aspects. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Dabiri C, Hotton J, Wehbe K, Gornes H, Garbar C, Guillemin F, Ceccato V. Assessment of the Grisotti oncoplastic procedure for the management of central breast tumors. Breast J 2021; 27:595-602. [PMID: 34251074 DOI: 10.1111/tbj.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Grisotti technique consists to excise central breast tumor with nipple areolar and mobilize a dermo-glandular flap which is de-epithelized in order to reshape the breast and recreate an areola. The objective was to assess oncological results, postoperative side-effects, and patient and surgeon satisfaction rates resulting from this technique. MATERIALS AND METHODS From September 2016 to December 2019, 38 patients have been treated with a central breast tumor using the Grisotti technique. RESULTS The mean age was 61.6 ± 11. The median body mass index was 27 kg/m² [20-42]. Thirty one patients benefited from a sentinel lymph node dissection. Preoperative histology found a majority of invasive ductal carcinomas (IDC) (71%). There were no intraoperative complications, and the average operating time was 90 min [60-200]. Postoperative histology found IDC associated with ductal carcinoma in situ in 28 patients. The surgical margins were invaded in two patients (reoperated by mastectomy after adjuvant treatment) and invasion of a margin of less than 1 mm in another six patients (supplemented by re-excision). The main postoperative complications were an abscess of the operating site and a partial necrosis of the neo-areola. The appearance of the breasts after radiotherapy gives a high satisfaction rate, both for patients and for surgeons. CONCLUSION The Grisotti technique is an easily reproducible procedure without major complications. It makes it possible to perform a carcinological satisfactory central lumpectomy, correction of the central glandular defect, and reconstruction of a new areola.
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Affiliation(s)
- Clément Dabiri
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Karl Wehbe
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Hugo Gornes
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Christian Garbar
- Department of Pathological Anatomy and Cytology, Institut Godinot, Reims, France
| | | | - Vivien Ceccato
- Department of Surgical Oncology, Institut Godinot, Reims, France
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Lakhera KK, Patni S, Patni N, Jindal R. Practical approach to extensive cutaneous spread without any underlying malignancy: a rare presentation of Paget's disease of breast. BMJ Case Rep 2020; 13:13/4/e233600. [PMID: 32245836 DOI: 10.1136/bcr-2019-233600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paget's disease of the breast is a rare intraepithelial malignancy involving the nipple-areola complex, often associated with an underlying in-situ or invasive carcinoma in the breast parenchyma. Most of the cases disease is usually limited to nipple-areola or surrounding periareolar skin. We are reporting a case of extensive Paget's disease, involving entire breast skin and even part of abdominal wall skin without any underlining breast pathology, which is a rare presentation.
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Affiliation(s)
- Kamal Kishore Lakhera
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sanjeev Patni
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Nidhi Patni
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Rohit Jindal
- Department of Surgical Oncology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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9
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Yao Y, Sun L, Meng Y, Zhuang Y, Zhao L, Yu Q, Si C. Breast-Conserving Surgery in Patients With Mammary Paget's Disease. J Surg Res 2019; 241:178-187. [DOI: 10.1016/j.jss.2019.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/21/2019] [Accepted: 03/21/2019] [Indexed: 10/26/2022]
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Gaurav A, Gupta V, Koul R, Dabas S, Sareen R, Geeta K, Arora V, Parikh PM, Aggarwal S. Practical consensus recommendatons for Paget's disease in breast cancer. South Asian J Cancer 2018; 7:83-86. [PMID: 29721469 PMCID: PMC5909301 DOI: 10.4103/sajc.sajc_107_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Paget's disease of the breast is a rare type of cancer of the nipple-areola complex and that is often associated with an underlying in situ or invasive carcinoma. Diagnosis and treatment of Paget's disease is controversial. Expert oncologists discuss on the update on the approaches of Paget's disease diagnosis and its treatment options. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at this practical consensus recommendations for the benefit of community oncologists.
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Affiliation(s)
- A. Gaurav
- Department of Endocrinology and Surgery, SGPGI, Lucknow, Uttar Pradesh, India
| | - V. Gupta
- Department of Surgical Oncology, BLK Super Specialty Hospital, New Delhi, India
| | - R. Koul
- Department of Surgical Oncology, Sir Ganga Ram Hospital, New Delhi, India
| | - S. Dabas
- Department of Surgical Oncology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - R. Sareen
- Department of Surgical Oncology, Indraprastha Apollo Hospital, New Delhi, India
| | - K. Geeta
- Department of Surgical Oncology, Max Hospital, New Delhi, India
| | - V. Arora
- Department of Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Purvish M. Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S. Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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Aguayo-Carreras P, Bonilla-García L, Pérez-López I, Cuenca-Barrales C, Tercedor-Sánchez J. Paget's Disease of the Breast: A dangerous imitator of eczema. Sultan Qaboos Univ Med J 2018; 17:e487-e488. [PMID: 29372097 DOI: 10.18295/squmj.2017.17.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/29/2017] [Accepted: 11/16/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Paula Aguayo-Carreras
- Department of Dermatology, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Laura Bonilla-García
- Department of Gynecology & Obstetrics, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Israel Pérez-López
- Department of Dermatology, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Carlos Cuenca-Barrales
- Department of Dermatology, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Jesús Tercedor-Sánchez
- Department of Clinical Management Dermatology, Hospital General Universitario Virgen de las Nieves, Granada, Spain
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Dubar S, Boukrid M, Bouquet de Joliniere J, Guillou L, Vo QD, Major A, Ali NB, Khomsi F, Feki A. Paget's Breast Disease: A Case Report and Review of the Literature. Front Surg 2017; 4:51. [PMID: 29109950 PMCID: PMC5660109 DOI: 10.3389/fsurg.2017.00051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/29/2017] [Indexed: 11/13/2022] Open
Abstract
Paget’s disease of the breast is a rare cancer. This typical clinical case illustrates the different epidemiological, clinical, histological, therapeutic, and evolving aspects of the disease. We report a case of Paget’s disease in a 43-year-old woman who presented eczema of the nipple. Mammography and ultrasounds did reveal a lesion in situ. The patient was scheduled for mastectomy and sentinel node biopsy. She had chosen a radical bilateral surgery. The histological diagnosis was Paget’s disease of the breast with a carcinoma in situ. There was no metastasis in either of the sentinel nodes. Paget’s disease must be considered with the presence of a persistent eczematous involvement of the nipple, which does not respond to local treatment. Ultrasounds, mammography, and magnetic resonance imaging can allow searching an underlying cancer and guiding the surgical management. There is no evidence at this time that one of the two surgical techniques (conservative or mastectomy) would improve survival. The prognosis depends on the presence of a palpable mass and the invasiveness of the cancer.
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Affiliation(s)
- S Dubar
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - M Boukrid
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | | | - L Guillou
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - Quoc Duy Vo
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - A Major
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - N Ben Ali
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - F Khomsi
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
| | - A Feki
- Department of Gynecology-Obstetric, Cantonal Hospital of Fribourg, Fribourg, Switzerland
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Surgical treatment in Paget's disease with invasive ductal carcinoma: an observational study based on SEER. Sci Rep 2017; 7:45510. [PMID: 28422090 PMCID: PMC5395813 DOI: 10.1038/srep45510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/28/2017] [Indexed: 12/23/2022] Open
Abstract
The aim is to analyse the clinical presentation, treatment and outcomes in patients with Paget’s disease with invasive ductal carcinoma (PD-IDC), with special emphasis on the role of surgical treatment. Using data obtained by the Surveillance, Epidemiology, and End Results (SEER) program from 2010–2013, we investigated the differences in characteristics, overall survival (OS), and breast cancer-specific mortality (BCSM) between patients with PD-IDC and those with invasive ductal carcinoma (IDC). Compared with IDC group, patients with PD-IDC had a better prognosis and lower mortality in adjusted analyses. In the multivariate analysis of cases with PD-IDC, history of ALND was significantly associated with OS while Her2 status were associated with BCSM. Further, subgroup analysis demonstrated no difference between surgical treatment subgroups for either OS or BCSM. The results demonstrated that PD-IDC appears to alter the association between prognosis and Her2 status. Meanwhile, breast-conserving surgery with radiotherapy may be a feasible treatment alternative and sentinel lymph node biopsy should be considered as an appropriate treatment for patients with PD-IDC.
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14
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Maladie de Paget du mamelon. IMAGERIE DE LA FEMME 2016. [DOI: 10.1016/j.femme.2016.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wong SM, Freedman RA, Stamell E, Sagara Y, Brock JE, Desantis SD, Golshan M. Modern Trends in the Surgical Management of Paget's Disease. Ann Surg Oncol 2015. [PMID: 26202552 DOI: 10.1245/s10434-015-4664-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE We examined the incidence and modern national trends in the management of Paget's disease (PD), including the use of breast-conserving surgery (BCS), mastectomy, axillary surgery, and receipt of radiotherapy. METHODS Using surveillance, epidemiology and end results (SEER) data, we identified 2631 patients diagnosed with PD during 2000-2011. Of these patients, 185 (7%) had PD of the nipple only, 953 (36.2%) had PD with ductal carcinoma in situ (PD-DCIS), and 1493 (56.7%) had PD with invasive ductal carcinoma (PD-IDC). Trends in age-adjusted incidence, primary surgery, sentinel lymph node biopsy (SLNB), and axillary lymph node dissection were examined. Multivariable logistic regression was used to evaluate factors associated with receipt of BCS and radiotherapy. RESULTS A decrease in the age-adjusted incidence of PD occurred from 2000 to 2011 (-4.3% per year, p < 0.05). The overall rates of mastectomy in the PD only, PD-DCIS, and PD-IDC groups were 47, 69, and 88.9%, respectively. Only in the PD-IDC group did the proportion of patients undergoing BCS increase significantly, from 8.5% in 2000 to 15.7% in 2011 (p = 0.01). Of those who underwent axillary surgery, the proportion of patients undergoing SLNB increased from 2000 to 2011. In adjusted analyses, Paget's subgroup, older age, central tumor location, low/intermediate grade, tumor size <2.0 cm, SEER region, and year of diagnosis after 2006 were significantly associated with receipt of BCS. CONCLUSIONS The incidence of Paget's disease has decreased over time while modern trends in local therapy suggest that BCS, SLNB, and adjuvant radiotherapy remain underutilized.
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Helme S, Harvey K, Agrawal A. Breast-conserving surgery in patients with Paget's disease. Br J Surg 2015; 102:1167-74. [DOI: 10.1002/bjs.9863] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/06/2014] [Accepted: 04/20/2015] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Paget's disease of the breast is a rare condition that is associated with underlying breast cancer in the majority of patients. The conventional treatment for Paget's disease has been mastectomy, but there is an increasing trend to consider breast-conserving surgery (BCS) in selected patients. Owing to the uncommon nature of the disease, research studies tend to be small and retrospective. This systematic review presents the published evidence regarding BCS for patients with Paget's disease with a focus on patient selection and oncological safety.
Methods
A search of Ovid and PubMed databases was conducted to identify all papers published regarding BCS for Paget's disease.
Results
The search identified 172 papers of which 43 were clinically relevant. BCS is a safe alternative to mastectomy, provided a clear surgical margin is achieved and adjuvant radiotherapy used. However, patients with Paget's disease should be assumed to have underlying breast cancer, and these cancers tend to have poor biological profiles. When BCS is considered, careful preoperative investigation should be undertaken to identify the presence and extent of an underlying cancer. These cancers can be mammographically occult, multifocal or multicentric. Although the evidence is limited, there may be a role for MRI in selecting patients with Paget's disease for BCS.
Conclusion
Patients with Paget's disease are candidates for breast conservation with appropriate preoperative investigations. Oncological outcomes are equivalent to those of mastectomy if surgical margins are achieved and adjuvant radiotherapy is given.
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Affiliation(s)
- S Helme
- Breast Department, Queen Alexandra Hospital, Portsmouth, UK
| | - K Harvey
- Breast Department, Queen Alexandra Hospital, Portsmouth, UK
| | - A Agrawal
- Breast Department, Queen Alexandra Hospital, Portsmouth, UK
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Sripathi S, Ayachit A, Kadavigere R, Kumar S, Eleti A, Sraj A. Spectrum of Imaging Findings in Paget's Disease of the Breast-A Pictorial Review. Insights Imaging 2015; 6:419-29. [PMID: 26142549 PMCID: PMC4519816 DOI: 10.1007/s13244-015-0415-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/08/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aimed to demonstrate imaging features of Paget's disease of breast, which is an extremely uncommon malignancy that presents with changes in the nipple-areolar region that may or may not be associated with an underlying in situ component or invasive cancer. METHODS AND RESULTS Mammography is the initial investigation of choice, having a high sensitivity especially in cases where a palpable mass is present. The addition of ultrasound improves the accuracy of mammography. When both mammography and ultrasound are negative, MRI may detect an underlying mass or ductal carcinoma in situ (DCIS). CONCLUSION The surgical management of Paget's disease includes mastectomy with or without axillary dissection, though breast conservation surgery in the form of wide local excision can also be done in a selected group of patients. Management should be based on both clinical and imaging findings, including mammography and ultrasound, with MRI playing a crucial role in defining the extent of involvement. Teaching Points • To differentiate Paget's disease from other chronic skin conditions. • Mammographic and ultrasound findings of histopathologically established Paget's disease. • When ultrasound and mammogram are negative, MRI may detect underlying malignancy.
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Affiliation(s)
- Smiti Sripathi
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India,
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Li YJ, Huang XE, Zhou XD. Local Breast Cancer Recurrence after Mastectomy and Breast-Conserving Surgery for Paget's Disease: A Meta-Analysis. ACTA ACUST UNITED AC 2015; 9:431-4. [PMID: 25759627 DOI: 10.1159/000368431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Paget's disease (PD) of the breast is a rare presentation of breast malignancy. Mastectomy has been considered the standard of care, but several studies have shown that breast-conserving surgery (BCS) with radiotherapy is an alternative option. According to the literature, the total recurrence rate is as high as 20-40%. In an effort to enable a rational therapy decision, we compiled and analyzed the available data on PD. METHODS Pubmed, Web of Knowledge, and China Journal Net were searched for studies concerning treatment for PD between 1990 and 2013. A meta-analysis was performed to compare the effect of different treatments. RESULTS 7 studies with a total of 685 patients were included. The cumulative local recurrence rate was 7.6%, 5.6% among women undergoing mastectomy and 13.2% among those treated with BCS. Compared to the BCS group, mastectomy showed significant differences in terms of local recurrence (odds ratio = 0.38, 95% confidence interval 0.21-0.69; p = 0.001). CONCLUSION Since not all currently available diagnostic and therapeutic options (magnetic resonance imaging, radiotherapy, tamoxifen) were systematically used in the studies included in this meta-analysis, it may be presumptuous to suggest that mastectomy is the right choice for all patients with PD in a modern interdisciplinary setting. Rather we can conclude that all efforts should be undertaken to assure local control since BCS is not equivalent to mastectomy in the treatment of PD.
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Affiliation(s)
- Yu-Jie Li
- Department of Surgical Oncology, Ningbo No. 2 Hospital of Zhejiang Province, China
| | - Xiao-E Huang
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang Province, China
| | - Xiao-Dong Zhou
- Department of Surgical Oncology, Yuyao People's Hospital of Zhejiang Province, China
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Kijima Y, Yoshinaka H, Shinden Y, Hirata M, Nakajo A, Arima H, Okumura H, Kurahara H, Ishigami S, Natsugoe S. Oncoplastic breast surgery for centrally located breast cancer: a case series. Gland Surg 2014; 3:62-73. [PMID: 25083497 PMCID: PMC4115775 DOI: 10.3978/j.issn.2227-684x.2013.11.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/11/2013] [Indexed: 11/14/2022]
Abstract
Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We herein report the results of OBS in Japanese patients with centrally located breast cancer (CLBC) and Paget's disease. We performed OBS combining partial mastectomy and immediate volume replacement on patients with non-ptotic and/or small breasts, and volume reduction surgery for patients with ptotic breasts, as reported in Western countries. Japanese encounters are described in this report as a case series.
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Affiliation(s)
- Yuko Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Heiji Yoshinaka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Munetsugu Hirata
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hideo Arima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiroshi Okumura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
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Poortmans P, Marsiglia H, De Las Heras M, Algara M. Clinical and technological transition in breast cancer. Rep Pract Oncol Radiother 2013; 18:345-52. [PMID: 24416578 DOI: 10.1016/j.rpor.2013.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/08/2013] [Accepted: 08/05/2013] [Indexed: 12/01/2022] Open
Abstract
This article is a summary of the conference "Clinical and technological transition in breast cancer" that took place in the Congress of the Spanish Society of Radiation Oncology, placed in Vigo (Spain) on June 21, 2013. Hugo Marsiglia and Philip Poortmanns were the speakers, the first discussed about "Clinical and technological transition" and the second about "EORTC clinical trials and protocols".
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Affiliation(s)
- Philip Poortmans
- Radiotherapy Department, Institute Verbeeten, Tilburg, The Netherlands
| | - Hugo Marsiglia
- Radiotherapy Department, Instituve Gustave Roussy, Villejuif, France
| | | | - Manuel Algara
- Radiotherapy Department, Parc de Salut Mar, Barcelona, Spain
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Sandoval-Leon AC, Drews-Elger K, Gomez-Fernandez CR, Yepes MM, Lippman ME. Paget’s disease of the nipple. Breast Cancer Res Treat 2013; 141:1-12. [DOI: 10.1007/s10549-013-2661-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/02/2013] [Indexed: 11/24/2022]
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22
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Oncoplastic breast surgery combining partial mastectomy with immediate breast reshaping using a keyhole-shaped skin glandular flap for Paget’s disease. Surg Today 2013; 44:1783-8. [DOI: 10.1007/s00595-013-0687-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Rzaca M, Tarkowski R. Paget's disease of the nipple treated successfully with cryosurgery: a series of cases report. Cryobiology 2013; 67:30-3. [PMID: 23665146 DOI: 10.1016/j.cryobiol.2013.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/14/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Paget's disease of the nipple is a rare form of breast malignancy. Underlying breast cancer, either in situ or invasive accompanies lesions of the nipple in most of the cases. The connection between both entities and their exact origin remains unclear. Nevertheless, underlying ductal breast cancer is often confined to the central, subareolar part of the breast. Radical mastectomy, although successful, seems to be too mutilating treatment in the era of breast sparing surgery. Studies describing breast conserving surgery performed without adjuvant treatment are rare and the patients not numerous. Due to low incidence of the disease, there are no randomised trials conducted which could show the optimal method of treatment. MATERIALS AND METHODS We performed cryosurgery of the affected nipple-areola complex (NAC) in treatment of six patients with Paget's disease of the nipple who presented general contraindications or lack of consent for surgery. RESULTS With a follow up ranging from 60 to 121 months (average 94) we obtained very good results in terms of disease specific survival: there were two cases of recurrent disease, confined to the scar and treated successfully with cryosurgery again; four patients are alive without disease. Death was not related to cancer in the remained two cases. CONCLUSIONS Cryotherapy is successful form of treatment of localised Paget's disease of the nipple--especially in face of contraindications for surgery or lack of patient's agreement for operational treatment.
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Affiliation(s)
- M Rzaca
- Regional Specialist Hospital, Department of Surgical Oncology, ul Kamieńskiego 73A, 51-124 Wrocław, Poland.
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An Unusual Case of Mammary Paget's Disease Diagnosed Using Dynamic Contrast-Enhanced MRI. Case Rep Radiol 2013; 2013:206235. [PMID: 23607031 PMCID: PMC3625544 DOI: 10.1155/2013/206235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Mammary Paget's disease is a rare presentation of breast cancer. At clinical examination, it is characterized by skin lesions of the nipple-areola complex, almost always a sign of malignancy. In fact, it is often associated with an underlying mammary ductal carcinoma in situ (DCIS) or invasive carcinoma. An underlying carcinoma is also common in women with negative mammography and ultrasound (US); in these cases, magnetic resonance imaging (MRI) is a diagnostic tool useful in the detection of occult cancer. We described an unusual case of mammary Paget's disease with underlying DCIS, in a patient without nipple-areola complex alterations and/or palpable lump. On suspicion of Paget's disease, the patient underwent MRI examination that proved useful for an accurate diagnosis. Biopsy confirmed dynamic MRI findings.
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25
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Lim HS, Jeong SJ, Lee JS, Park MH, Kim JW, Shin SS, Park JG, Kang HK. Paget disease of the breast: mammographic, US, and MR imaging findings with pathologic correlation. Radiographics 2012; 31:1973-87. [PMID: 22084182 DOI: 10.1148/rg.317115070] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Paget disease is a rare malignancy of the breast characterized by infiltration of the nipple epidermis by adenocarcinoma cells. The clinical features of Paget disease are characteristic and should increase the likelihood of the diagnosis being made. An important point is that more than 90% of cases of Paget disease are associated with an additional underlying breast malignancy. Paget disease is frequently associated with ductal carcinoma in situ (DCIS) in the underlying lactiferous ducts of the nipple-areolar complex; it may even be associated with DCIS or invasive breast cancer elsewhere in the breast, at least 2 cm from the nipple-areolar complex. Nevertheless, mammographic findings may be negative in up to 50% of cases. Magnetic resonance (MR) imaging can be useful in patients with Paget disease for evaluation of the nipple-areolar complex and identification of an additional underlying malignancy in the breast. The appropriate surgical treatment must be carefully selected and individualized on the basis of radiologic findings, especially those obtained with breast MR imaging.
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Affiliation(s)
- Hyo Soon Lim
- Department of Radiology, Chonnam National University Medical School, 8 Hack Dong, Dong Ku, Gwangju 501-757, South Korea.
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26
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Cufer T, Cardoso F, Werutsky G, Bonnefoi H, Brain E, Cataliotti L, Dal Lago L, Delaloge S, Jassem J, van Tienhoven G, Van't Veer L, Westenberg H, Marreaud S, Bogaerts J, Rutgers E, Cameron D. The EORTC Breast Cancer Group: major achievements of 50 years of research and future directions. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Paget's disease of the breast is a rare type of cancer of the nipple–areola complex and that is often associated with an underlying in situ or invasive carcinoma. This article provides an overview and we review the main clinicopathological and therapeutic features of mammary Paget's disease.
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Affiliation(s)
- Cansu Karakas
- Department of Experimental Radiation Oncology at University of Texas MD Anderson Cancer Center, Houston, TX, USA
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28
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Dominici LS, Lester S, Liao GS, Guo L, Specht M, Smith BL, Golshan M. Current surgical approach to Paget's disease. Am J Surg 2011; 204:18-22. [PMID: 22036205 DOI: 10.1016/j.amjsurg.2011.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/25/2011] [Accepted: 07/25/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Paget's disease constitutes between 1% and 3% of all breast malignancies, which makes defining standard surgical therapy difficult. We sought to identify preoperative factors that would select patients for successful breast conservation. METHODS Fifty-one patients with Paget's disease underwent surgical therapy between October 1998 and January 2010. Clinical presentation of Paget's disease, preoperative imaging, pathologic tumor characteristics, as well as surgical, radiation, and adjuvant therapies were reviewed. RESULTS Thirty-seven percent underwent breast conservation whereas 63% underwent mastectomy. Twelve patients presented with a palpable mass, and all were treated with mastectomy. Twenty-two patients underwent a mammogram, identifying extensive abnormality requiring mastectomy. Magnetic resonance imaging added to surgical planning in 52% of patients who participated in the study. None of our patients had a local/regional recurrence at 29 months of follow-up evaluation. CONCLUSIONS Paget's disease of the breast can be treated with breast conservation in a properly selected subset of patients. Successful breast conservation was achieved in patients without a palpable finding, a benign mammogram, and a normal magnetic resonance imaging scan.
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Affiliation(s)
- Laura S Dominici
- Department of Surgical Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA
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Geffroy D, Doutriaux-Dumoulins I, Labbe-Devilliers C, Meingan P, Houdebine S, Sagan C, Dejode M, Ricaud-Couprie M. [Paget's disease of the nipple and differential diagnosis]. ACTA ACUST UNITED AC 2011; 92:889-98. [PMID: 22000610 DOI: 10.1016/j.jradio.2011.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 11/17/2010] [Accepted: 07/01/2011] [Indexed: 11/19/2022]
Abstract
Clinical evaluation of the nipple-areolar complex is a routine component of the breast screening examination. All persistent unilateral nipple lesion should be viewed with suspicion and Paget's disease of the nipple should be considered. The diagnosis is established by nipple scrape cytology. It is a rare variant of ductal carcinoma in situ. The breast imaging work-up should include a search for an underlying malignancy, present in over 80% of cases, not infrequently multifocal. Preoperative MRI is useful if breast conservative surgery is contemplated because of the high rate of occult malignancy on mammograms and ultrasound. Erosive adenomatosis of the nipple is a benign process that may simulate Paget's disease isolated to the nipple. Less frequently, pagetoid basal cell carcinoma, Bowen's disease and melanoma may be more difficult to differentiate clinically and share the unilateral and chronic features of Paget's disease. Biopsy is needed for diagnosis. Cutaneous extension of a breast cancer is rare but should be suspected in patients with retraction and/or fixed nipple. Eczema is characterized by the bilateral nature of the process, the absence of nipple deformity, the presence of flare-ups and the favorable response to local steroid therapy.
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Affiliation(s)
- D Geffroy
- Centre René-Gauducheau, service d'imagerie médicale, institut de cancérologie de l'Ouest, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.
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Onoe S, Kinoshita T, Tamura N, Nagao T, Kuno H, Hojo T, Akashi-Tanaka S, Tsuda H. Feasibility of breast conserving surgery for Paget's disease. Breast 2011; 20:515-8. [PMID: 21689938 DOI: 10.1016/j.breast.2011.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 05/04/2011] [Accepted: 05/29/2011] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The standard treatment for Paget's disease of the breast is mastectomy. Since it is frequently associated with underlying carcinoma, many surgeons are reluctant to choose breast conserving surgery for Paget's disease. PATIENTS AND METHODS We retrospectively analyzed a series of 59 patients with Paget's disease who had undergone mastectomy at the National Cancer Center Hospital between 1963 and 2009. RESULTS In 55 of 59 cases (93%) there was underlying carcinoma in the ipsilateral breast. Clinically, 27 (46%) patients had no evidence of other tumors, but 23 (85%) had underlying histopathologically confirmed carcinoma. Based on the data from this subset, cone excision with a 3-cm radius and a 4-cm radius could completely resect any underlying malignancy in 74% and 85% of patients, respectively. CONCLUSION As Paget's disease is frequently accompanied by underlying intraductal and/or invasive carcinoma, patients should be carefully selected for breast conserving surgery.
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Affiliation(s)
- Shunsuke Onoe
- Breast Cancer Group, Surgical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Mátrai Z, Gulyás G, Tóth L, Sávolt A, Bidlek M, Szabó E, Pesthy P, Kunos C, Bartal A, Kásler M. [Breast conserving oncoplastic surgery in the treatment of centrally located malignant breast tumors]. Orv Hetil 2010; 151:2105-12. [PMID: 21147681 DOI: 10.1556/oh.2010.29017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Central breast neoplasms account for 5 to 20% of breast cancer cases. For decades, they have been traditionally treated with mastectomy. The high incidence of involvement associated with these tumors necessitates nipple and areola resection. Oncoplastic surgical techniques, in well selected cases, enable the achievement of adequate cosmetic results following a radical central quadrantectomy along with the Nipple-Areola Complex. The present paper summarizes the indications, techniques and results of breast conserving surgeries of central breast tumors.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Általános és Mellkassebészeti Osztály Budapest Ráth György u. 7-9. 1122.
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Siponen E, Hukkinen K, Heikkilä P, Joensuu H, Leidenius M. Surgical treatment in Paget's disease of the breast. Am J Surg 2010; 200:241-6. [DOI: 10.1016/j.amjsurg.2009.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 10/19/2022]
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Corsi F, Sartani A, Galli D, Alineri S, Uccelli M, Fontana A, Foschi D. Usefulness of Preoperative Diagnosis with Magnetic Resonance Imaging for Conservative Surgery in Paget's Disease of the Breast. Breast Care (Basel) 2010; 5:26-28. [PMID: 22619638 PMCID: PMC3357163 DOI: 10.1159/000272304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: Paget's disease (PD) of the breast is a relatively rare condition (incidence 1-3%) among primary breast cancers [6]. It presents with suggestive symptoms like erythema, nipple bleeding and ulceration. PATIENT AND METHODS: A 76-year-old woman was followed up for cancer of the left breast that had been operated 10 years before. During her annual check, a lesion suggestive of PD was detected. Mammography and ultrasound were performed, without evidence of a new breast lesion. In consideration of a possible underestimation of the real extent of the disease, we performed magnetic resonance imaging (MRI). RESULTS: MRI showed an irregularly shaped tissue infiltrating the external side of the right breast. The pathologically bright signal involved the nipple and deformed the areolar skin. The characteristics of the increased signal were typical of a hypervascular invasive pattern and for tumoral neoangiogenesis. We performed a mastectomy with sentinel lymph node (SLN) biopsy, with evidence of a DIN 3 carcinoma associated with PD of the nipple at the final pathology report. CONCLUSION: The MRI was instrumental for the assessment of the existence and extent of malignant disease in a patient with PD but without a palpable lesion detectable with negative ultrasound and mammography.
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Affiliation(s)
- Fabio Corsi
- Department of Surgery, L. Sacco Hospital, University of Milan, Italy
| | | | - Davide Galli
- Department of Surgery, L. Sacco Hospital, University of Milan, Italy
| | | | - Matteo Uccelli
- Department of Surgery, L. Sacco Hospital, University of Milan, Italy
| | - Andrea Fontana
- Department of Surgery, L. Sacco Hospital, University of Milan, Italy
| | - Diego Foschi
- Department of Surgery, L. Sacco Hospital, University of Milan, Italy
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Kim HS, Seok JH, Cha ES, Kang BJ, Kim HH, Seo YJ. Significance of nipple enhancement of Paget's disease in contrast enhanced breast MRI. Arch Gynecol Obstet 2009; 282:157-62. [PMID: 19838723 DOI: 10.1007/s00404-009-1244-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 09/28/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate significance of nipple enhancement of Paget's disease in contrast enhanced (CE) breast MRI. METHODS Ten patients of biopsy proven Paget's disease were included in this study. Preoperative mammogram and ultrasonogram (US) were obtained in all 10 patients, and 8 patients underwent CE breast MRI prior to surgery. Mammographic and US findings were reviewed retrospectively. On MRI, morphology (flattening or asymmetry or thickening) and enhancement of pathologically involved nipple were analyzed comparing with the opposite side, and also reviewed the abnormal enhancing lesion in the breast parenchyma. RESULTS Morphologic changes of the nipple were detected in 2 out of 10 patients by mammogram and 6 out of 10 patients by US. On MRI, morphologic change was also revealed in 7 patients and abnormal enhancement of involved nipple was observed in all 8 patients. Associated parenchymal enhancing lesions were proved to be DCIS (7 out of 10) and invasive ductal carcinoma (2 out of 10). Remaining one patient had no underlying breast parenchymal malignancy. CONCLUSION CE breast MRI allows for the correct detection of nipple involvement of Paget's disease even when clinical information or mammographic/US findings are not provided.
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Affiliation(s)
- Hyeon Sook Kim
- Department of Radiology, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Paget's disease of the nipple is an unusual epidermal presentation of underlying breast cancer. It presents as eczematous change or erythematous ulceration, but may also be an incidental histological finding in a mastectomy specimen. Approximately half of the underlying cancers are invasive, the remainder being ductal carcinoma in situ, and only rarely is there no associated malignancy. Routine clinical and mammographic assessment may significantly underestimate the extent of disease, but MRI may increase the sensitivity in detecting occult malignancy. Mastectomy maximizes local control; however, selected cases can be treated by nipple conisation with radiotherapy. Sentinel node biopsy is the standard of care for axillary staging in the clinically and ultrasonically node-negative case. Almost all invasive cases overexpress human EGF receptor-2 and, therefore, are likely to benefit from adjuvant chemotherapy and herceptin.
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Affiliation(s)
- Seema Seetharam
- Seema Seetharam, MBBS, MRCS, Hedley Atkins Breast Unit, Guy's Hospital, London SE1 9RT, UK, Tel.: +44 207 188 4239, Fax: +44 207 188 4239,
| | - Ian S Fentiman
- Ian S Fentiman, MD, DSc, FRCS, Hedley Atkins Breast Unit, Guy's Hospital, London SE1 9RT, UK, Tel.: +44 207 188 4239, Fax: +44 207 188 4239,
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Partridge A, Winer JP, Golshan M, Bellon JR, Blood E, Dees EC, Sampson E, Emmons KM, Winer E. Perceptions and management approaches of physicians who care for women with ductal carcinoma in situ. Clin Breast Cancer 2008; 8:275-80. [PMID: 18650159 DOI: 10.3816/cbc.2008.n.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Limited previous data suggest that heterogeneity exists in the treatment approaches for women with ductal carcinoma in situ (DCIS). We sought in a longitudinal cohort study of women with DCIS to assess the attitudes and management approaches toward DCIS among physicians who provide care to women. MATERIALS AND METHODS Eligible physicians were invited to participate in a 1-time mailed survey. A financial incentive and reminders were used to enhance the response rate. Physician perception of risks associated with DCIS for patients and management approaches were evaluated. RESULTS Two hundred and eight physicians were identified, and 151 (73%) completed the survey. Respondents had a median age of 49 years (range, 32-75 years), and most were surgeons or medical oncologists (66%). Eighty-eight percent reported seeing an average of >or= 1 new patient with DCIS per month. In a multivariable model, physicians who cared for proportionately fewer patients with breast cancer were more likely to view DCIS as a riskier disease to a patient's overall health compared with physicians who cared for more women with breast cancer (odds ratio, 2.2; 95% CI, 1.1-4.6; P = .036). Physicians exhibited differences in management approaches when considering theoretical patients with DCIS and did not use consistent terms when speaking with patients with DCIS. CONCLUSION Substantial variation exists among physicians regarding perceptions and management approaches for women with DCIS. In some settings, risks of physician-recommended therapy might outweigh benefits. Further evaluation of the effects of physician management approaches and attitudes about DCIS on patient outcomes is warranted.
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Affiliation(s)
- Ann Partridge
- Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Faure C, Escalon J, Brémond A, Mignotte H, Pérol D, Delay E. Chirurgie oncoplastique pour le traitement des tumeurs mammaires centrales. ANN CHIR PLAST ESTH 2008; 53:112-23. [DOI: 10.1016/j.anplas.2007.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
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Caliskan M, Gatti G, Sosnovskikh I, Rotmensz N, Botteri E, Musmeci S, Rosali dos Santos G, Viale G, Luini A. Paget's disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat 2008; 112:513-21. [PMID: 18240020 DOI: 10.1007/s10549-007-9880-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Accepted: 12/19/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paget's disease of the breast is an uncommon presentation of breast malignancy, accounting for 1-3% of all the breast tumors and presents in different histopathologic patterns: in association with an underlying invasive or non invasive carcinoma, or without any underlying neoplasia. In the literature, different methods are used for the treatment. Mastectomy with or without axillary dissection has been considered as the standard treatment procedure for many years. Several studies have already shown that breast conservation with radiation therapy is an oncologically safe option. Regarding the axillary approach, several studies have documented the presence of positive sentinel lymph node even in Paget's disease alone. The objective of this study was to retrospectively analyze outcome of patients affected by Paget's breast disease and to define our institutional experience. PATIENTS AND METHODS Between May 1996 and February 2003, 114 patients with confirmed Paget's disease of the breast were retrieved and underwent surgery at the European Institute of Oncology of Milan, Italy. The median age of the patients was 54 years at the time of the diagnosis. In our study, the histopathological examination of the operated specimen revealed one hundred seven patients with Paget's disease associated with an underlying invasive or non invasive carcinoma, and seven patients without underlying carcinoma. Patients underwent either conservative breast surgery or mastectomy, with or without sentinel lymph node biopsy and/or axillary surgery. Each patient was evaluated after surgery at a multidisciplinary meeting to selecting systemic therapy. RESULTS Seven patients had "pure" Paget's disease of the breast and one hundred seven had the disease associated with an underlying carcinoma. As surgical techniques 71 mastectomies and 43 breast conserving surgeries have been performed. Complete axillary dissection was done in patients with clinically positive lymph node and/or sentinel lymph node biopsy positive. Sentinel lymph node biopsy was performed in nineteen patients with invasive component and five were positive and underwent axillary dissection. Eleven sentinel lymph node biopsies were done in patients with non invasive component and none of them was positive. Adjuvant systemic therapies were based on the final tumor, node and metastasis stage: thirty patients received adjuvant chemotherapy alone, fourteen received endocrine treatment alone, twenty-six patients were evaluated to receive both chemo and endocrine therapy. The median duration of follow up was 73 months and was updated in the last 6 months. Five patients developed local recurrence, one had regional recurrence, another two had loco-regional recurrences and fourteen had distant metastasis as a first event. Malignancy-related deaths were censored in the statistical analyses cancer for and due to another tumor in eleven patients. Additionally, deaths were not related to malignancy totally in thirteen patients. CONCLUSIONS Screening examination and imaging techniques are fundamental. Breast conserving surgery combined with breast irradiation for patients with invasive and non invasive breast carcinoma has become the treatment of first choice. All surgical conservative approaches should include the complete nipple-areolar complex and margins of resected specimen free of tumor. Thanks to the evolution of the conservative approach, good cosmetic result can be obtained. To be informed about the axillary lymph node status and to avoid the patient to have a second surgical approach, sentinel lymph node biopsy should be performed.
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Affiliation(s)
- Mujgan Caliskan
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
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MRI Identifies Otherwise Occult Disease in Select Patients with Paget Disease of the Nipple. J Am Coll Surg 2008; 206:316-21. [DOI: 10.1016/j.jamcollsurg.2007.07.046] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 07/19/2007] [Accepted: 07/20/2007] [Indexed: 11/20/2022]
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Wagner E, Schrenk P, Huemer GM, Sir A, Schreiner M, Wayand W. Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer. Breast J 2007; 13:557-63. [PMID: 17983395 DOI: 10.1111/j.1524-4741.2007.00492.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36). Two of 33 (6%) patients scheduled for BCS had a secondary mastectomy and immediate reconstruction due to involved margins. After a median follow-up of 42 month (range 17-99 months) in the BCS group and 43 months (range 16-118 months) in the mastectomy group local and regional recurrences as well as systemic disease were comparable between both groups. The postoperative cosmetic result after BCS as evaluated by the patients was rated as excellent in 80% and good in 20% with no poor result. BCS followed by radiation therapy is a feasible alternative to mastectomy in patients with retroareolar breast cancer.
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Affiliation(s)
- Elke Wagner
- Second Department of Surgery--Ludwig Boltzmann Institute for Surgical Laparoscopy, AKH Linz, Austria
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Dalberg K, Hellborg H, Wärnberg F. Paget’s disease of the nipple in a population based cohort. Breast Cancer Res Treat 2007; 111:313-9. [DOI: 10.1007/s10549-007-9783-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 10/03/2007] [Indexed: 10/22/2022]
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Kawawa Y, Okamoto Y, Oharaseki T, Takahashi K, Kohda E. Paget's disease of the breast in a woman with neurofibromatosis. Clin Imaging 2007; 31:127-30. [PMID: 17320780 DOI: 10.1016/j.clinimag.2006.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 11/20/2006] [Accepted: 12/01/2006] [Indexed: 11/30/2022]
Abstract
Paget's disease of the breast is a rare and specific type of breast carcinoma in the nipple or areola. On the other hand, neurofibromatosis (NF) is also a rare neurocutaneous disease, which is inherited and affects mainly the skin and the nervous system. In addition, NF is rarely associated with malignant tumors. We present a case of Paget's disease concomitant with NF type 1 in a 66-year-old woman.
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Affiliation(s)
- Yoko Kawawa
- Department of Radiology, Toho University School of Medicine, Japan
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Haddad N, Ollivier L, Tardivon A, Thibault F, El Khoury C, Neuenschwander S. Apport de l’IRM dans la maladie de Paget du sein. ACTA ACUST UNITED AC 2007; 88:579-84. [PMID: 17464257 DOI: 10.1016/s0221-0363(07)89858-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Evaluate the usefulness of MRI in local staging of Paget disease of the breast. MATERIALS AND METHODS Clinical, radiological (mammographies, MRI), and histological data were analyzed in six female patients presenting Paget disease of the breast. The criteria for analysis in MRI were the following: morphology of the aureola-nipple plaque (thickening, regularity of the contour) and the type of enhancement after injection of contrast medium (signal intensity/time curve), detection of abnormal enhancing in the mammary gland, and ganglion areas. RESULTS None of the patients presented a palpable mass or a suspicious anomaly on mammography. On MRI, the aureola-nipple plaque was morphologically abnormal in four cases, with suspicious enhancement in two cases (two cases of ductal carcinoma in situ) and normal enhancement in two cases (one case of ductal carcinoma in situ). In the two other cases, the aureola-nipple plaque was normal (one case of ductal carcinoma in situ). Distant abnormal enhancement of the aureola-nipple plaque was noted in two cases (one case of ductal carcinoma in situ and one benign lesion). CONCLUSION The MRI aspect of the aureola-nipple plaque in Paget disease shows little concordance with the histological results. MRI can be useful in detecting distant lesions when there is no clinical sign nor a suspicious mammography.
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Affiliation(s)
- N Haddad
- Service de Radiologie, Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex 05, France.
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Abstract
Paget's disease is an intra-epidermal adenocarcinoma seen over the nipple/areola (mammary Paget's disease) or in extramammary body zones, such as the anogenital and perineal skin and the axilla. Mammary and extramammary Paget's disease share many common clinicopathological features but also show several differences, namely, with regard to pathogenesis and association with underlying malignancies. Indeed, mammary Paget's disease is as a rule associated with an underlying breast carcinoma whereas association of extramammary Paget's disease with underlying (skin or visceral) malignancies occurs much less frequently. We review here the main clinicopathological and therapeutic features of mammary and extramammary Paget's disease.
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Affiliation(s)
- J Kanitakis
- Department of Dermatology, Ed. Herriot Hospital, Lyon, France.
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Joseph KAP, Ditkoff BA, Estabrook A, El-Tamer MB, Banarjee S, Schnabel FR. Therapeutic Options for Paget's Disease: A Single Institution Long-Term Follow-Up Study. Breast J 2007; 13:110-1. [PMID: 17214812 DOI: 10.1111/j.1524-4741.2006.00381.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zakaria S, Pantvaidya G, Ghosh K, Degnim AC. Paget’s disease of the breast: accuracy of preoperative assessment. Breast Cancer Res Treat 2006; 102:137-42. [PMID: 17028984 DOI: 10.1007/s10549-006-9329-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 07/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Routine preoperative assessment may not accurately assess the extent of underlying cancer in patients with Paget's disease (PD) of the breast. We performed this study to correlate findings on clinical examination and mammography with pathologic results and outcomes in women with PD. METHODS An IRB-approved retrospective review identified all patients with PD between 1975 and 2000. Clinical exam and mammographic findings were recorded, and information on recurrence and survival was obtained from medical records. RESULTS Univariate analyses identified palpable mass and suspicious mammogram as risk factors significantly associated with a worse outcome. Patients were therefore categorized by combinations of these two preoperative factors. All patients with a palpable mass and a suspicious mammogram had invasive cancer. In the subgroup of 40 women with a benign mammogram and no palpable mass, invasive cancer occurred in 5% and the majority (68%) had ductal carcinoma in situ which extended beyond the nipple. Women with a palpable mass and a suspicious mammogram had significantly worse survival compared to those with a benign mammogram and no palpable mass (P = 0.008). With a median follow-up of 6.4 years, five local recurrences occurred in patients with invasive cancer who underwent mastectomy. CONCLUSION In women with PD, a palpable mass or suspicious mammogram portends a high likelihood of invasive cancer. Underlying cancer is common even in women with a benign mammogram and no palpable mass. Although breast conservation is an attractive option in patients with PD, mammography and physical exam may significantly underestimate the presence and extent of underlying disease.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Axilla
- Breast Neoplasms/diagnosis
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Lymphatic Metastasis
- Mammography
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Paget's Disease, Mammary/diagnosis
- Paget's Disease, Mammary/surgery
- Preoperative Care
- Retrospective Studies
- Sensitivity and Specificity
- Ultrasonography, Mammary
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Affiliation(s)
- Shaheen Zakaria
- Department of General Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Capobianco G, Spaliviero B, Dessole S, Cherchi PL, Marras V, Ambrosini G, Meloni F, Meloni GB. Paget's disease of the nipple diagnosed by MRI. Arch Gynecol Obstet 2006; 274:316-8. [PMID: 16622685 DOI: 10.1007/s00404-006-0160-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 03/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Paget's disease of the breast is a rare manifestation of breast carcinoma. CASE REPORT The patient presented with a red lesion of the left nipple-areola complex. Breast physical examination, ultrasonography and mammography were normal bilaterally. Magnetic resonance imaging (MRI) correctly depicted Paget's disease of the nipple. Before surgery the patient underwent biopsy of the lesion that showed Paget's disease of the breast associated with an underlying ductal carcinoma in situ. The patient underwent left mastectomy and unilateral axillary lymph node dissection. The patient refused the breast-conserving surgery because she was afraid that she could have a recurrence of the carcinoma. Microscopy of the lesion confirmed the MRI diagnosis. CONCLUSION MRI was very useful and accurate to diagnose Paget's disease of the breast without palpable mass, ultrasonographic and mammographic findings.
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Affiliation(s)
- Giampiero Capobianco
- Department of Pharmacology, Gynecology and Obstetrics, University of Sassari, Viale San Pietro 12, Sassari 07100, Italy.
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Franceschini G, Masetti R, D'Alba P, Consorti G, Picciochi A. Conservative treatment with nipple-areolar resection for subareolar breast cancer. Breast J 2006; 12:91-2. [PMID: 16409599 DOI: 10.1111/j.1075-122x.2006.00196.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen CY, Sun LM, Anderson BO. Paget disease of the breast: Changing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer 2006; 107:1448-58. [PMID: 16933329 DOI: 10.1002/cncr.22137] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Paget disease is an uncommon presentation of breast cancer that increased in incidence in the U.S. between 1973 and 1987. Characterized by malignant crusting or ulceration of the nipple, Paget disease can present in 1 of 3 ways: 1) in conjunction with an underlying invasive cancer, 2) in conjunction with underlying ductal carcinoma in situ (DCIS), or 3) alone without any underlying invasive breast carcinoma or DCIS. Paget disease can be treated with breast conservation by undergoing central lumpectomy. The objective of this study was to determine how the incidence, presentation, biomarkers, operative approach, and outcome of Paget disease have evolved in the U.S. since 1988. METHODS Between 1988 and 2002, 1738 women who were diagnosed with Paget disease were reported in the 9 registries of the Surveillance, Epidemiology, and End Results Program. To the authors' knowledge, the current study on tumor characteristics, surgical intervention, and survival represented the largest series of Paget disease ever reported. RESULTS Although the overall incidence of breast cancer increased between 1988 and 2002, the incidence of Paget disease concomitantly decreased by 45% (95% confidence interval, from -35% to -53%). This decreasing incidence was greatest for Paget disease associated with invasive cancer or DCIS. Invasive cancer associated with Paget disease more commonly was estrogen receptor negative, progesterone receptor negative, and of high histologic grade. Even when 60% of the disease was located centrally, only 293 of 1642 patients with Paget disease (18%) who were treated surgically underwent central lumpectomy. Patients with Paget disease who underwent breast conservation had outcomes equivalent to the outcomes among patients who underwent mastectomy. CONCLUSIONS The incidence of Paget disease associated with underlying invasive cancer or DCIS decreased since 1988. Patients who underwent central lumpectomy and patients who underwent mastectomy for Paget disease had similar outcomes; nonetheless, most patients who were candidates for preservation underwent mastectomy.
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Affiliation(s)
- Chin-Yau Chen
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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